Training

Here's a quick summary:

1. You need to train hard to make optimal progress, but if you train so hard that it affects the quality of your other workouts or causes so much stress that your performance declines, then this is a bad approach.
2. If you train a muscle once a week, you can push it much harder without too many negative effects than if you train a muscle several times a week.
3. Testing your performance with workouts that challenge your body is a good way to find out what you're capable of, and preparing for these challenges can give your training motivation a significant boost.
4. If you don't push yourself to your limits from time to time, you'll lose sight of what it means to train really hard. An occasional lesson on pain in the gym will allow you to look at things soberly.
5. Throwing up during a workout may seem hardcore, but throwing up during a workout simply means you've misjudged your food intake and your workout, which doesn't make you truly hardcore.

Feeling the burn. Training yourself into the ground. Feeling a killer sore muscle. Throwing up. Not being able to walk after a leg training day. Not being able to drive after an arm training day. All of this is something of a medal of honor for many exercisers, but none of it will guarantee that your training session was positive and will lead to improvement. Despite this, many of us prefer to focus on these elements rather than objective progression.

Why? Because seemingly insane workouts make you seem hardcore - like a warrior. Your training often turns into a test of how much pain and suffering you can endure. But do you really have to train yourself into the ground in every single training session to make progress?

I have the feeling that I have achieved something

I used to train TV sports presenter Joe Buck. We did a lot of training with the weight sled, tire flipping and farmer's walks in conjunction with strength training. We didn't give ourselves much rest during the workouts (partly due to the fact that we kept conversation to a minimum) and as a result, every single one of those workouts was extremely challenging.

Then he said: "What I like about training with you is that I feel like I've achieved something."

At first glance I took this as a compliment, but after giving it some thought, I rethought my approach to training. I wanted to be known as the guy who gets results, not the guy who can inflict pain on you. Totally killing a client in the gym is easy - you don't have to be particularly intelligent to achieve this. Achieving results over the long term is a different story. This takes knowledge and athletic ability.

However, this experience still taught me the lesson that the average exerciser judges the value of a training session by how uncomfortable and painful it felt.

Many of my clients had previously been trained by sadistic trainers, so when they started training with me, I had to work hard to convince them that being able to walk after a training session didn't mean it wasn't a good training session. However, they only accepted what I told them when they started to get good results.

Is it really necessary to literally kill yourself in the gym? If you want to make rapid progress, you need to train hard - much harder than most people train. Unfortunately, once you're past a certain threshold, training even harder won't lead to faster gains and could even hinder your long-term progress.

I'll give you a few examples from my own training. I recently performed a CrossFit/strength training session that consisted of 10 rounds of the following:

• 4 * Atlas deadlifts from floor to shoulder (175 pounds)
• 4 * front squats (225 pounds)
• 4 * Bench press (225 pounds)

This was performed every minute on the full minute, which meant that I started with one exercise at the beginning of each full minute and had one minute to perform that exercise before moving on to the next exercise. If performing 4 reps took 30 seconds, this meant that I had 30 seconds rest before moving on to the next exercise.

Even though the weights on this workout weren't gigantic, I can tell you that 4 front squats at 225 pounds twenty seconds after atlas lift is tough. I felt great after the training session. Completely drained, everything hurt and I felt more tired than I had in a long time. I was excited. I had the feeling of having "achieved something". I was so proud and pumped up that I planned to do similar training sessions three times a week. However, this resolution didn't last long. The next morning I had the worst sore muscles of my life - quadriceps, biceps, shoulders, back - everything felt like it had been through the wringer. And I felt exhausted, tired and unmotivated. These sore muscles and my generally poor state of health lasted for 5 days. I tried to exercise once during those 5 days, but stopped after 10 minutes because it wouldn't have helped.

Now I'm not someone who would give up training because of sore muscles, but this soreness was excessive. The question I had to ask myself was: "Was this workout really so productive that it was worth missing four other workouts?" Any fool could see that this answer is a definite "no". You need to train hard to make optimal progress, but if you train so hard that it affects the quality of your other training sessions, or causes so much stress that your performance diminishes, then this is a poor approach.

Those who are literally killing themselves and making progress

I'm going to say it anyway - it's hard to argue with results. In fact, there are many guys and gals who achieve very good results by pushing themselves to the brink of death every time they train. I have the following thoughts on this: How far you can go into the danger zone depends on your training frequency. If you only train a muscle once a week, you can "punish" it much harder without any negative effects than if you train it several times a week. What difference will it make if you can't run for five days after a leg training day if you only train your legs once a week? However, for someone like me who believes in the importance of training frequency and considers it more important than other training variables, it is much more difficult to find the right dose. You need to stimulate your muscles enough to make progress, but not push them so hard that it interferes with the next training session.

How much 'punishment' you can handle during a training session and recover sufficiently also depends on the amount of weight you move relative to your 1RM weight.

If your average weight during your training sessions is 60 to 70% of your 1RM weight, then you will be able to venture much further into the pain zone without any negative effects than if you use 80 to 90% - let alone 90 to 100%.

I believe that the body can recover from super intense muscle training and metabolic training, which is especially the case when using the right pre-, intra- and post-workout nutrition. The problems start when you combine training sessions that literally kill yourself with the use of heavy weights, which is why I am not surprised when I see bodybuilders who are able to literally kill themselves when training using techniques such as descending sets, rest-pause, partial repetitions, etc., as they are using weights that are quite low relative to their capacities.

One should also not overlook the role of "altered physiology" when it comes to recovery.

Drugs such as steroids, growth hormones and others can help you recover much faster from training. If you train with chemical support, a workout where you are literally killing yourself will not have a long-lasting negative impact on your training capacity. I'm not saying that everyone who makes good gains by training like a maniac is on steroids - I'm just saying that chemical support is one of the factors that can allow an exerciser to train longer and harder and still recover adequately.

We all have our specific physiology and respond differently to training Some people respond better to volume and others to heavy weights. Similarly, some people seem to be "indestructible" while others can only cope with a limited amount of stress.

I once trained an Olympic athlete who was super explosive - the most explosive person I had ever seen. He was very strong (he was bench pressing almost 200 kilos at a bodyweight of under 80 kilos), but he could only cope with a maximum of 6 to 8 work sets in a training session - not sets per exercise, but total sets per training session. On the other hand, I also know guys who can do set after set for 2 to 3 hours day after day.

We get good at ignoring fatigue associated with training At first we may feel a little tired and our motivation wanes a little, but as dedicated strength athletes we force ourselves to go train anyway. After a while, we start to get used to the state of exhaustion, which we soon see as our normal state. And even if we are only functioning at 70% of our capacity, we don't even realize it.

Someone who has nothing else to do but train, such as a professional athlete, will obviously recover from training faster than someone with a full-time job, especially if it is a physically or mentally demanding job. A Russian weightlifter who is paid by the government and has unlimited access to massages, physiotherapy and recovery methods such as ice baths and saunas will be able to train for six hours a day, whereas the same workload would kill you in no time.

Can training like a madman in the gym be beneficial?

While I believe in focusing on progression and being able to train each muscle more often, I do believe that truly grueling workouts to the point of death may have some merit. Going to muscle failure and beyond (with descending sets, rest-pause, partial reps after reaching muscle failure, etc.) is indeed justifiable when it comes to stimulating muscle growth.

If I were an advocate for training to complete muscle failure, I could easily make a solid case for it. I could start by quoting Dr. Vladimir Zatsiorsky: "A muscle fiber that has been recruited but not fatigued has not been trained." While you may not have to go to muscle failure and beyond to train the fiber, training to muscle failure provides you with some sort of insurance that you have fatigued a lot of muscle fibers.

The counter-argument is that exhausting motor units is not the only way to make a muscle grow. Cell signaling (including mTOR activation) and hormonal responses are examples of other things that can lead to muscle growth. Similarly, muscle exhaustion is not necessary for strength gains, as improving neural factors will lead to gains in strength without exhausting every muscle fiber.

Testing your mettle with challenging workouts is an excellent way to test your physical abilities.

Plus, preparing to be ready for these challenges can significantly increase your motivation to train. I use challenge-based workouts in my training once or twice a month. These can take different forms: the Atlas stone/front squat/bench press workout I mentioned above; a 100 repetition bench press; 100 repetitions of power cleans with 90 kilos, 50 repetitions of squats.... These are things I have done in the past. Even though all these workouts have immobilized me for days, they have also given me a lot of motivation and taught me to push myself hard.

Working out like a maniac in the weight room can change your perception of heavy training.

You don't have to kill yourself in the weight room to progress at an optimal rate, but you do have to train very hard. However, if you don't really push yourself to your limits from time to time, then you will lose the sense of what hard training really is. In fact, you may lose your drive and train a little less hard from month to month. You won't even notice that you're slacking off! On a scale of 1 to 10, your average training intensity should be 8, but if you never go up to 10, then you will lose the sense of what an 8 on that scale really is. For this reason, many exercisers actually only go up to a 5 or 6 when they think they are at an 8. An occasional lesson in pain will allow you to see things in perspective. Performing level "10" workouts can be useful, but you need to understand how they affect your body and plan your training accordingly. You should realize that you won't be in optimal shape for a few days after such a training session, so you should plan either rest days or a few lighter training days in the days following your challenge.

More on training to muscle failure...and beyond

There are insane Crossfit/GPP and insane bodybuilding workouts. The former involves killing yourself with metabolic training to the point where you throw up. The latter refers to inducing as much pain as possible on every single set, going to the point of complete muscle failure and beyond. As I mentioned earlier, there is indeed a possible benefit to training to muscle failure. You will ensure that you have exhausted a maximum amount of muscle fibers and thus made that set as effective as possible to stimulate adaptation. Remember that muscle failure itself is not necessary to optimally exhaust the muscle fibers, but it is a useful insurance policy. I want to emphasize that muscle failure does not always have to be due to complete muscle fiber exhaustion. Muscle failure can occur due to depletion of energy reserves (depletion of the phosphagen system also known as the ATP, creatine phosphate energy system), an inability of the nervous system to continue recruiting motor units, a loss of muscle fiber response to neural drive (this can be caused by muscle acidosis) and muscle fiber exhaustion.

Training to muscle failure is therefore not necessarily an indicator that you have completely exhausted the maximum amount of muscle fibers and training to muscle failure does not necessarily make a significant difference to finishing the set one repetition before reaching muscle failure. However, training to muscle failure and beyond can increase cell signaling, which is responsible for an increase in protein synthesis and can also lead to a local release of growth factors. So it makes sense that training to muscle failure can effectively stimulate muscle growth.

The downside is that the cost-benefit ratio prohibits this. There is no doubt that you can stimulate muscle growth by training beyond muscle failure. I will use my economics analogy at this point: You have a finite amount of money to spend on your training. A set where you go to muscle failure or beyond is more costly than a regular set where you stop one repetition before reaching muscle failure. So if you decide to go the super-intense route, you'll need to cut back elsewhere to prevent your training budget from running out - which will lead to stagnation and even overtraining. You should also be aware that as a steroid-free trainee you will have less training money available. Anabolic steroids provide you with a higher amount of training money to invest.

However, if you are a bodybuilder who only trains each muscle group every 5 to 7 days, then it is probably fine to use a reasonable number of sets to muscle failure and beyond. However, if you're training each muscle group three times a week (or even just twice a week), then you're probably begging for trouble.

Throwing up during your workout: A badge of honor for particularly hard exercisers?

These days, throwing up during a hard training session is considered hardcore or a sign of an extremely hard and intense workout, but is it really? The main reason you throw up during an intense training session is a redirection of blood flow away from your stomach and towards your muscles. The body will always send more blood to where it is needed most. During intense workouts, your muscles need extra oxygen and more metabolic waste products need to be transported away from the muscles. As a result, the body will send more blood to the muscles to supply them with more oxygen and at the same time transport waste products away from the muscles. Of course, this also means that less blood is transported to the stomach. This is where the problems start. If you are still digesting a large meal when the blood flow is diverted away from the stomach to the muscles, then nausea and vomiting can occur. So if you are vomiting during a training session, it simply means that:

1. Your workout is causing a very large shift in blood flow towards the muscles.
2. You have poorly timed your food intake and training in relation to each other, which doesn't really make you hardcore.

So which types of training are most likely to make you vomit? Logically, anything that requires large amounts of blood to be sent to your muscles. This applies to any type of exercise that requires high energy production, but of particular interest here is physical work that leads to a large accumulation of metabolic waste products. Hard training with the weight sled, 400 to 800 meter sprints where you give it your all, CrossFit WODs and bodybuilding workouts that cause a large accumulation of lactic acid are types of training that can cause vomiting during the workout due to the need to remove the accumulated metabolic waste products. So yes, the more intensely you perform these types of activities, the more likely you are to revisit your lunch.

So in a way, it's true that working out to the point of vomiting could mean you're able to endure a lot of pain and suffering in the gym. Reaching the point where your muscles produce so many waste products that you feel sick requires a very high pain tolerance - so you're probably hardcore in that respect. If you are able to reach the point where you throw up, you are probably someone who is physically and mentally very tough. But is this a goal worth striving for? Training in extremely humid weather to the point of heat stroke is also a sign that you can endure some pain and discomfort, but it's not really conducive to rapid progression with optimal gains. Throwing up is not an anabolic stimulus. The act of throwing up will not cause gains in strength or muscle mass, but can it hinder your progress? If you occasionally throw up during training, it probably won't affect your gains. However, a few things happen after you throw up that can make it harder for you to get the most out of your training session:

• You lose electrolytes, which will make it harder for you to perform at your maximum and recover
• You waste nutrients that could be used for growth and recovery
• You can ruin your appetite for several hours after training
• You can ruin your training session. Not everyone is able to continue training hard after throwing up.
• You risk becoming dehydrated. And dehydration leads to a significant reduction in your performance.

As you can see, there is no huge risk of muscle loss, but it still remains counterproductive to optimal training, growth and recovery.

Conclusion

1. Training a muscle to the point where you are unable to move at the end of a training session can limit your capacity to train that muscle again in the near future. It might work for those who only train each muscle once a week, but if you train each muscle more frequently, this type of training could be counterproductive.
2. We all have limited recovery capacity and limited capacity to grow through physical work. If you are investing in sets beyond muscle failure, then you should realize that you should reduce your overall volume, otherwise your progress may stagnate.
3. Some people can recover faster due to their physiology (genetics or chemical support) and benefit from training cleans with near-death experiences, but most can't if they do these types of workouts too often.
4. Irregular, demanding workouts performed once every few weeks can be a very effective strategy from both a physiological and psychological perspective.
5. Progression is everything. If you are not making progress in strength, performance and/or body composition from week to week, then it could be that your training or nutrition is not optimal.

If pushing yourself to the extreme limits and beyond in training isn't leading to progression from week to week, then it's likely that this very training is holding you back.

Source: https://www.t-nation.com/training/how-hard-do-you-need-to-work-out
By Christian Thibaudeau

Q: I have calves that look like Tara Lipinski's calves. Should I work with high or low reps? Should I do standing calf raises or seated calf raises? Should I put a bullet in my head or take a good dose of anthrax?

A: Calf training requires all the brainpower you can muster. Calves are problematic from a physiological point of view. A lot of exercisers are unhappy with their calves because the load parameters for lower leg development are much more limited than, say, arm training. Unlike something like your bicep training, your calf repertoire is limited. To compensate for this, you need to be much more careful when it comes to manipulating your reps, sets and rest intervals to add variety to your calf workout.

Another problem is the limited range of motion in calf exercises. Let's say you're doing squats. The range of motion for squats is large and it's easy to vary the tempo. For example, you can take 3, 4, 5 or more seconds to perform the eccentric part of the movement. With calf exercises, however, you have a limited range of motion and cannot vary the tempo as easily as with squats or other exercises. During the Nagano Olympics, some of my athletes from different disciplines were discussing on the bus the value of the calf training programs I had given them, specifically focusing on the program I had created for Luke Saunder, one of my alpine skiers. One of the skiers recalled how Luke had come to training camp with a completely new pair of calves and the ski company rep had freaked out because he had to fit him with a new pair of ski boots. I remember Luke wanting a calf training program because muscular calves can prevent knee injuries in alpine skiing (they provide a kind of cushioning that prevents the skier's knees from forming too high a lateral angle when skiing downhill).

When I got home, I pulled out the program I had given Luke. It's a program that would serve anyone well. Here it is:

Day 1: High Volume

Exercise A: Calf Superset*

A1) Seated calf raise

• 3 x 10-5-5 (One set of 10 reps followed by two sets of 5 reps) with a 101 tempo (1 second to lower the weight, no rest and 1 second to lift the weight)

A2) Donkey calf raises

• 3 x 30-50 with a 101 tempo

* After performing a set of exercise A1, go straight to performing a set of exercise A2. Then pause for two minutes before performing the next superset.

Exercise B: Standing calf raise

B1) Standing calf raises

• 10 x 10-30 with a 111 tempo, 10 seconds **

**In other words, you will perform a long extended set where you pause for 10 seconds between each mini-set, lowering the weight between sets.

After day one, you'll probably feel a burning sensation in your calves that makes you want to call the fire department. It could also be that your gait resembles that of Homer Simpson's 80-year-old father.

Day 2: Low volume (should be performed 48 hours after day 1)

Exercise A: Standing calf raise, double descending set

A1) Standing calf raise, double descending set

• 3 x 10-10-10 (in other words, two descending sets) with a 121 tempo,*** and 90 seconds rest between sets.

*** The pause is taken in the lowest stretched position and you should make sure to pause for a full 2 seconds.

This program should give you insane gains in muscle mass. As you can see, you will be performing a large number of total repetitions. I have found that you need sufficient training frequency and volume, but that you cannot use high volume and high frequency at the same time. Therefore, I recommend training the calves twice within a 5-day cycle: with a training session with many sets (16) and many total repetitions (250 to 510), as well as a training session with few sets (3) and a low amount of total repetitions (90). I know people who have gained 1.5 to 2.5 centimeters of calf circumference in just 30 days with this program.

Q: When I do bench presses, my shoulders hurt like crazy. Should I train around the pain, or take up stamp collecting as a new hobby instead?

A: It's very likely that one of the following three shoulder problems is responsible for your pain:

A muscle imbalance:

When the strength ratio between two muscle groups is unbalanced, it can lead to misalignment. For example, if the strength of your pectorals is proportionally much higher than that of the external rotators of the humerus (teres minor and infraspinatus), then you will probably feel a sharp pain in the upper, anterior part of the upper arm (this problem is often misdiagnosed as inflammation of the biceps tendon). There are plenty of other examples of displaced muscle strength relationships, but explaining them all here is beyond the scope of this column.

A development of adhesions:

One of the undesirable side effects of years of training with weights, is a development of adhesions in soft tissue and other body structures. Adhesions are a result of the load used and the total volume of repetitions. In other words, the more sets and repetitions you perform and the stronger you get, the more adhesions you will develop. This build-up of connective tissue can occur within a muscle, between muscle groups or between nerve and muscle. Adhesions can occur in any muscle structure, but the area most commonly responsible for shoulder pain during bench presses is the subscapularis muscle. The good news is that you can quickly find and fix these adhesions with soft tissue treatment techniques known as Active Release Techniques®.

A lack of mobility:

Not stretching your muscles regularly can encourage injuries to occur. You don't have to become a yoga grandmaster now, but regular shoulder girdle stretches before your upper body workouts will do wonders when it comes to keeping your shoulders healthy and functional.

A real life example

Some time ago, a good friend and IFBB pro called me and told me that he was going to have athroscopic surgery on his shoulder next week. He was excited as this surgery would be expensive and he would have to go through a long period of rehab afterwards which would prevent him from competing and earning a living. I told him that he should definitely consult an Active Release Techniques® (ART) specialist before such an operation. (The original diagnosis was impingement syndrome and supposedly surgery to remove part of the bone in the shoulder to make room for the muscle was the only option).

When this IFBB pro came into the office, he had not trained for 4 months due to his hellish pain, as even lowering an empty Olympic barbell (20 kilos) caused him excruciating pain. After 45 minutes of treatment, the ART specialist sent him to the gym to do a shoulder workout. I had the opportunity to accompany him and could hardly believe how he completed 5 repetitions of bench presses with almost 150 kilos. Five days later he was able to do 6 repetitions with this weight completely pain-free. About a month later, he was almost back in competition shape and training for the next competitions.

The most important point to realize is that you don't have to suffer or stop training just because you have shoulder pain. Depending on the individual problem, you should find an experienced trainer to help you put together a suitable training program or seek treatment from an experienced therapist.

Q: Every time I go to the gym, I see a guy doing upper body twists with a broomstick on his shoulders. Are these guys really training their external obliques (external oblique abdominal muscles) and slimming their waistline, or is it all just pointless jumping around?

A: I see two different issues here: Training the lateral abdominal muscles and reducing the waist circumference. Training the external oblique abdominal muscles will not ensure a slim waist. On the contrary, strongly developed lateral abdominal muscles will be detrimental to the V-shape of your upper body and the classic bodybuilding look. However, if you are a judoka or a wrestler and you are more concerned with function than attracting girls, then stronger side abs will help you with your throws and wrestling.

As for twisting your upper body with a broomstick, this will do absolutely nothing for your lateral abs. Why? A broomstick puts minimal stress on the lateral abdominal muscles. Since you're not fighting gravity, you're not putting any kind of overload on these muscles. Effective training for the obliques requires a much heavier load than you can create with a broomstick. As for a slim waist, this has more to do with reducing body fat than choosing any exercise that specifically targets this area. Since there is no empirical or scientific evidence of localized fat loss, all the abdominal exercises in the world will not help you reduce your lifelines, regardless of training volume. Effective body fat reduction is the result of a combination of diet manipulation, optimal training volume and the right training intensity.

Q: How would you recommend incorporating Power Cleans - my favorite exercise - into a mass/strength training program?

A: Power Cleans should always be used on leg day as the first exercise of the program, as you are using a high speed of movement and accelerating the weight to the maximum when performing this exercise. Therefore, this exercise should be performed when the nervous system is still fresh. Be sure to perform more than six repetitions per set and rest sufficiently between sets (3 to 5 minutes).

Q: What are your views on the theory of training with static contractions and how would one use static repetitions or partial repetitions with extremely heavy weights? Since the very beginning of my career as a strength & conditioning coach, I have been a firm believer in using a power rack to promote massive gains in strength and muscle mass after applying the methods of Don Ross, Rasch, Bill Starr and Anthony Ditillo. This program is the most effective. The average, somewhat advanced bodybuilder, can expect to increase their personal bests on curls by 5 to 12 kilos and on close bench presses by 15 to 20 kilos with this program. This is quite impressive as these gains are achieved within such a short time frame of only 3 to 4 weeks.

The physiological basis of this program is what sports scientists Fleck & Kraemer and O'Shea refer to as "functional isometric contractions" (FIC). Over 40 years ago, this training method was introduced to players of the iron game under the name "isometric training", which is a combination of the terms "isometric" and "isotinic". German weight training experts such as Letzelter & Letzelter and Hartmann and Tünnemann prefer the term "autotonic training" to describe this training method. The concept behind this protocol is to use the best that the isometric method has to offer in combination with a regular style of training. With FIC, you can utilize the specific joint angle strength gains of isometric training after pre-fatiguing the muscles involved using heavy repetitions over a short repetition range on the power rack.

Like any other training system, this system has its advantages and disadvantages:

Pros:

• Allows you to "uninhibit" the nervous system: can help you overcome psychological barriers to certain weights.
• Provides variety to your training program due to new challenges.
• Increases maximal strength in the specific areas trained. This type of training may be well suited for a powerlifter who has difficulty reaching the hyperextended arm position on the bench press or the upright position on the deadlift.

Disadvantages:

• It is time consuming to prepare the setup
• Produces strength gains in a range of plus/minus 15 degrees of range of motion. In other words, isometric holds with an elbow flexion of 130 degrees will only increase your strength in the range of elbow flexion between 115 and 145 degrees. This means that the first 115 degrees of elbow flexion will remain untrained.
• With certain exercises, this can easily develop into a kind of circus act, which can of course be quite entertaining. One of the books on the subject recommends heavy isometric holds in the top position of Scott curls. I once watched a boy try this with a weight heavier than his body weight. He made the mistake of trying to hold the weight too far down in the range of motion, which caused him to tumble forward over the Scott bench.

From: by Charles Poliquin
Source: https://www.t-nation.com/training/question-of-strength-1 , https://www.t-nation.com/training/question-of-strength-2 , https://www.t-nation.com/training/question-of-strength-3

Sir William Osler, the founder of modern medicine, once remarked "The greater the ignorance, the greater the dogmatism."

It's kind of ironic that modern medicine is so ignorant - and so dogmatic - when it comes to exercise and nutrition. It's not hard to see where this comes from. Pride. Presumption, even.

Medicine is one of the most challenging scientific fields. After 8 years of study, I take my Hippocratic oath within a few weeks. And then I still have 6 years as a junior doctor ahead of me. Some of my fellow students took even longer. That's a lot of time, a lot of learning and a lot of effort. And the responsibility? We make decisions every day that can mean the difference between life and death. Every time we examine a patient, we have the chance to see - or miss - a sign or symptom of a disease that could cost our patient their life or irreparably damage their health. We are among the best and the brightest, the best educated and the most influential people in the world. It's hard not to let that go to your head. At the end of the day, medicine is all about authority and knowledge. We know more about the human body in terms of health and disease and have more responsibility for it than anyone else.

Compare this to science, which is ultimately about ignorance. Science moves forward when we take a look at what we don't know and try to figure it out.

Needless to say, finding ignorance is one of the most important lessons a scientist can learn. In fact, you could say that this is the only job of a scientist. Doctors learn a lot about what science has discovered about the human body. But they are not trained to be scientists, or to think like scientists. A doctor knows what he knows and that's all there is to it.

Doctors have a lot of opinions on diet and exercise. Training with weights is not healthy. Working out with weights will damage your heart. You will ruin your joints. Squats are bad for your knees. Deadlifts are bad for your back. You should only train with light weights and high repetitions. You are too heavy and will die of a heart attack or diabetes if you don't lose weight. You are destroying your kidneys with all that protein. Creatine is bad for you. The only workout you need is cardio. I could go on for days. Most of us have heard it before. And many of us don't pay much attention to such statements. Some of us do and change the way we exercise. And almost all of us wonder how true these statements really are and whether we are destroying our bodies in our pursuit of strength and physical perfection. The real question, however, is how much attention should we pay to these experts?

As I've said before, medical education is extremely intense and extremely broad. It has to be. But there is also a lot that is not covered by this training. We learn the molecular structure of every amino acid (and most of us forget all about this after the biochemistry exam). We learn the equations for cardiovascular physiology. We learn the branches of every nerve and the origin and insertion point of every muscle in the human body. But we don't even learn the basics of healthy eating. We learn nothing about the adaptations of the cardiovascular and muscular systems in response to exercise. We don't learn about how insulin promotes the use of protein and creatine. We don't even learn what all the muscles in the human body actually do. We don't learn about the difference between myofibrillar and sarcoplasmic hypertrophy - or the training effects of high repetitions versus low repetitions. Heck, most doctors aren't even aware of the concept of high-intensity interval training - let alone how much more effective it is than steady-state cardio.

And yet doctors think that your opinion on proper nutrition and training actually matters. I honestly don't know whether to laugh or cry at this. All those years of training and everything I know about training and nutrition, I had to teach myself. And most of my colleagues don't even understand why I make such a big deal out of it. There's no other way to describe all of this than pathetic. In this article, I want to address some of these issues that doctors get completely wrong - sometimes because of ignorance when it comes to exercise physiology and nutrition, and sometimes because they don't know the limits of their own knowledge.

The following are just a few examples of things doctors get wrong with strength athletes:

Body composition

If you go by BMI, most serious strength athletes are overweight or even obese. There are a lot of dramatic studies out there about the health risks of being overweight, ranging from heart disease to stroke to cancer to dementia. I don't think this is a point where there is much ambiguity. Being fat is bad for you. The real question is whether BMI is a useful tool to gauge how fat you are. It seems like every time I go to the doctor, he (or his receptionist) mentions my BMI of 29 and tells me to lose weight.

Now, to be honest, it's been a while since I last saw the bottom row of my six-pack and my love handles have names of their own, but if I didn't have such well-defined glutes, my 32-waist jeans would slide down unhindered without a belt. I'm pretty sure that my "incipient obesity" has more to do with the fact that I barely fit into my size 56 jacket than with a dangerously high body fat percentage.

When a muscular person brings up this topic, doctors often respond something along the lines of "Okay, this system doesn't work for people with a lot of muscle, but it works fine for the average population."

Does it? Does it really? I have my doubts. Ultimately, BMI is based solely on height and weight and ignores everything else like bone structure and lean body mass, which can vary widely even within the so-called "normal" average population.

Some scientists at the Mayo Clinic had their own doubts - and with good reason, as it turned out (1). When they used the diagnostic power of BMI using the WHO's reference standard for obesity for men (25% body fat) and women (35% body fat), they found that only 36% of all obese men had a BMI of over 30. The majority of people who were carrying around unhealthy amounts of fat had a normal BMI or a BMI in the "overweight but not obese" range. And as if that wasn't bad enough, it turned out that in people with a BMI below 30, this correlated better with lean body mass than with body fat percentage. A study by another group of researchers from Canada came to similar conclusions (2). So using BMI doesn't really work well for the "normal" population either. As if not managing to identify two-thirds of people who need to lose weight wasn't bad enough, it also means that decades of population studies regarding the health risks of obesity are largely invalid.

Most people with a BMI over 30 are indeed obese. But nearly half of the American population with a BMI under 30 is also obese. This means that most of these studies drastically underestimate the health risks of obesity. This is not a concern for those of us in the MMA, lighter weight classes or figure class athletes. But for all the bodybuilders and strongmen out there who are carrying around a significant amount of adipose tissue, it means those extra pounds are more dangerous than your doctor would think.

The last thing I want to talk about is lean body mass. A lot of studies have found what many doctors consider the "paradoxical" effect. This says that people with a BMI in the overweight range (25 to 29.9) tend to live longer, have less heart disease, have a better chance of surviving cancer and suffer from fewer disabilities.

Studies that have compared BMI with body fat and lean body mass have concluded that people in the overweight range (but below the obese range) were not necessarily fatter than people in the so-called "normal" range, but that the extra body mass was more likely to be lean body tissue. Contrary to what your doctor might tell you about all the extra muscle mass you're carrying around, your training with weights is probably doing more for you than all that running does for a marathon runner.

But that doesn't mean that a greater amount of lean body mass doesn't have its drawbacks. Injuries occur when you push yourself hard and to the limit in the gym. This extra body mass and heavy weights put more strain on your joints, although this is balanced out by your muscles carrying more of the load and your connective tissue carrying less. The more weight you carry around, the harder your heart has to work.

More muscle means a faster metabolism and therefore a lower risk of dementia, diabetes and heart disease. But it also means more free radicals and potentially more inflammation, which means more stress on your endocrine system, your cardiovascular system and your brain, and possibly a higher rate of cancer. So is there such a thing as a point of diminishing returns? Is there a point where you have too much muscle mass? Maybe. But since population-based long-term studies have only ever used BMI, we don't know.

BMI is out of date and doesn't really serve its purpose - and not just for muscular people, but for everyone. You wouldn't let someone deadlift with their knees bent and their back round, and you shouldn't let people determine their own health status and weight loss goals based on BMI. Tell these people to use a body fat scale or get a skinfold measurement or a DEXA scan instead. Something so ingrained and so insidious needs to be attacked at every level by every person who knows better. Spread the word.

High blood pressure

High blood pressure is one of the most widespread chronic diseases. And even if there are no symptoms, high blood pressure can have devastating effects on your kidneys, brain and heart (3). This is why high blood pressure is considered so insidious - and also why doctors almost always check blood pressure regardless of the reason for your visit.

The time, resources and intensity with which the medical community attacks the problem of high blood pressure is entirely justified, but just as with BMI, our method for measuring blood pressure is less than perfect (albeit worlds better). If you really do have high blood pressure, then it is very important that it is treated. But what if it isn't? Whether it's the inconvenience, the cost or the side effects, no one wants to pop pills if it's not necessary. More pragmatic concerns have to do with private health insurance, where diagnosed health conditions existing at the time of taking out a policy can drive premiums up sharply, or even result in a rejection. The last thing you want in this area is to have a diagnosis of "high blood pressure" haunting your medical records for all time.

But back to measuring blood pressure. The only accurate way to measure blood pressure is to insert a catheter with a pressure gauge on the tip through an artery into your aorta. Not very practical - and not very fun either. This is the reason why doctors use a blood pressure cuff.

However, in really seriously ill people, blood pressure is also often measured using a catheter. In my limited experience as a young doctor, the readings from an arm cuff are consistent with direct intra-arterial blood pressure readings. But this is not always the case.

The cuff itself is a possible source of error. A cuff that is too small will measure values that are too high. A standard cuff is suitable for an upper arm circumference between 36 and 38 centimeters. But most people for whom we doctors use larger cuffs are usually quite overweight to obese.

It often doesn't occur to many doctors that a slim arm might simply be too big for a standard cuff. Even if you tell them beforehand that the standard cuff is too small, they often insist on trying this one first. For me, this cuff usually either fails completely when it comes to taking a reading or gives such an absurd blood pressure reading that the doctor gives up and uses a larger cuff. For many, however, where such a cuff is only slightly too small, this cuff will give readings that would be expected in a person with high blood pressure. This is a false positive. If I were you, I would ask the doctor to take a measurement with the larger cuff if the standard cuff gives a high reading.

The second problem is related to the fact that you have muscle and fat surrounding this artery, so the value measured by the cuff is a result of how the pressure from the artery is transmitted through fat and muscle. Fat, which is very compressible, can act like a sponge or shock absorber and lead to falsely low readings. I once had a patient who was so extremely obese that no one in the office was able to take a useful blood pressure reading on the upper arm. We ended up having to use the forearm. Muscles, on the other hand, are very tight and can lead to higher values than expected.

This is known as 'spurious systolic hypertension' (SSH) (4). In most people with high blood pressure, both the upper (systolic) and lower (diastolic) values are elevated (systolic >140 and diastolic >90). Some people suffer from what is called "isolated systolic hypertension" (ISH). In these people, only the upper value is elevated. This is most commonly seen in older people and we doctors believe that this is because the arteries of these people are no longer as elastic as in younger people due to calcium deposits on the walls of the arteries.

People who suffer from "false high systolic blood pressure" tend to be younger and not have major risk factors for health problems (obesity, smoking, high cholesterol) - in other words, not the people you would normally see "isolated systolic hypertension" in. They tend to differ from people with blood pressure in the normal range of the same age only in that they have a higher BMI and are more likely to exercise (5). "Unreasonably high systolic blood pressure" most likely has nothing to do with blood pressure and everything to do with the anatomy of the muscles in the person's arm.

So if you are diagnosed with high blood pressure, you should first check the size of the cuff and then look at the diastolic value. If this is below 90, there is a high probability that it is a case of "non-genuine high systolic blood pressure" and that you do not need medication.

Kidney function

It is a common dogma among doctors that a high protein diet is bad for your kidneys. As this topic has already been discussed extensively in numerous other articles, I don't want to go into too much detail here. The bottom line is that high protein intake may or may not be bad for your kidneys. We simply have no scientific evidence to suggest one or the other. However, this also means that your doctor has no scientific basis for telling you that you are destroying your kidneys. The idea that protein is harmful comes from studies done on people who suffered from kidney damage - people who suffered from either chronic renal insufficiency or chronic renal failure. For these people, there is no doubt - the higher the protein intake, the faster the deterioration of their kidney disease.

This makes sense when you think about it. These are people whose kidneys can't even cope with the basic demands their bodies place on them. Increasing the demands on the kidneys beyond this basic status cannot possibly be good. But can we apply these observations to people with normal and healthy kidneys? There is no reason to think that we can and plenty of reasons to think that we can't.

The kidneys are amazingly robust organs with a lot of excess capacity. In fact, you have to lose about 75% of the functional units (nephrons) in your kidneys before a kidney function test will show any changes. And that doesn't even take into account the fact that the kidneys can dramatically increase their filtration rate in healthy adults compared to resting levels. An analogous situation can be observed in the heart. In a healthy adult, HIIT or any kind of cardio training is good for the heart. But take a person who suffers from heart failure or serious coronary artery disease. For such a person, it's probably not a good idea to start with sprints up the stairs. This is also the reason that all erectile dysfunction medications have warnings on them that the user should ask their doctor if it is safe for them to have sex. If you take an already weakened heart and strain it, bad things can happen. But is that why you see doctors recommending that healthy people abstain from exercise?

Our next concerns about the kidneys are the blood tests that doctors do to determine how well the kidneys are functioning. There are two values that we are particularly interested in: The blood urea nitrogen (BUN) value and the blood creatinine (Cr) value. Blood urea nitrogen (BUN) is a waste product of protein metabolism. Creatinine is a breakdown product of creatine phosphate, which is found in your muscles, heart and brain. Doctors usually examine these levels using a simple blood test that shows them the concentration of both. And this is where things get tricky - and these are exactly the places where doctors can make wrong assumptions. The concentrations of these substances in your blood are affected by several factors, one of which is kidney function. The BUN concentration changes with your hydration status (low if you are well hydrated, high if you are dehydrated).

It also changes in response to too much protein that you consume and metabolize. The more protein you consume, the higher your BUN value will be. Creatinine levels, on the other hand, are much more stable. Creatinine is produced at a relatively constant rate - due to the constant process of muscle breakdown and rebuilding, more or less depending on how much muscle mass you have.

So the concentration in your blood has a lot to do with how much lean body mass you have. Having said that, it should be mentioned that there are certain things that can increase your creatinine levels. Serious infections or other stressors increase muscle breakdown as a consequence of cortisol and pro-inflammatory hormones circulating in your body. For the same reason, a particularly intense training session or competition can also greatly increase creatinine levels. There is a "normal range" for each of these levels. And people who have BUN and Cr blood levels outside these ranges often suffer from kidney problems. On the other hand, there are a lot of strength athletes who also have abnormal levels on these blood tests, which can cause them and their doctors to panic.

But these "normal" ranges are based on the assumption that you are also "normal" when it comes to all the factors I talked about earlier. A higher protein intake means a higher BUN blood value. Higher lean body mass means a higher blood creatinine level. Higher physical stressors (and a resulting increase in creatine turnover) means higher creatinine levels. Do you think any of these factors could apply to strength athletes? Damn right they do.

So the results of your blood test come back and your kidney values indicate possible problems. Your doctor will call you in a panic and tell you that you've destroyed your kidneys with all that protein and creatine and that you need to stop immediately. What do you do in a situation like this?

Well, your doctor has simply overextended himself. He really has no idea how your kidneys are doing and neither do you. But that's not a problem, because we doctors have the tools to directly calculate how well your kidneys are working - we just don't use them very often. It takes a urine sample. A bloody urine sample. The only way to find out if your kidneys are filtering waste products well enough is to see how much of it they are excreting. Sounds like common sense, doesn't it?

What I would do is ask for a creatinine clearance measurement. You will have to give up training for a few days, which will reduce your creatine to the baseline level of simple muscle turnover, but I wouldn't stop taking protein and creatine.

After you've given your body enough time to clear any possible stress-related increase in creatinine production, you'll come back for another blood test and urine sample. The lab will compare your creatinine blood concentration with the amount of creatinine in your urine. This will tell your doctor exactly how well your kidneys are excreting waste products and allow him to investigate all the ways in which you are "abnormal". As I said, it could turn out that your kidneys really are in bad shape, but more likely it's just the fact that you eat more protein and have more muscle mass than most.

Conclusion

Einstein once said "It is in no way a waste of time if we become practiced in analyzing from our own experience general concepts long held to be valid and in showing the circumstances on which their validity and usefulness depend and how they have evolved. This will break their excessive authority." You wouldn't be here if you didn't take your health seriously. This and your love of iron make you abnormal, which means that sometimes you don't fit the model that other people use to judge you - whether it's thinking you're a mindless powerhouse or determining the state of your health. It's important to understand the assumptions doctors base their thinking on. Sometimes these assumptions make no sense at all (as is the case with BMI) and other times you are just different enough from a "normal" person that "normal" methods simply don't apply.

References

1. Romero-Corral A. et al. Accuracy of Body Mass Index in Diagnosing Obesity in the General Adult Population. International Journal of Obesity 2008. 32(6):959-966.
2. Kennedy AP et al. Comparison of the Classification of Obesity by BMI vs. Dual Energy X-ray Absorptiometry in the Newfoundland Population. Obesity 2009. Apr 9.
3. Chobanian AV et al. Seventh Report of the JoinT National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003. 42:1206.
4. Hulsen HT et al. Spurious systolic hypertension in young adults; prevalence of high brachial systolic blood pressure and low central pressure and its determinants. Journal of Hypertension 2006. 24(6):1027-1032.
5. Krzesinski JM and Saint-Remy A. Spurious systolic hypertension in youth: what does it really mean in clinical practice? Journal of Hypertension 2006. 24(6):999-1001.

By Nikhil Rao
Source: https://www.t-nation.com/training/what-your-doc-doesnt-know-about-weightlifting